BUNDELKHAND UNIVERSITY JHANSI

INSTITUTE OF PHARMACY

2023-2024

TOPIC- GASTROINTESTINAL TRACT DISORDER

SUBMITTED TO SUBMITTED BY
DR NIRMALA PRAJAPATI ALFIYA
B.PHARMA
ROLL NO-111

INTRODUCTION
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The gastrointestinal (GI) tract represents one of the most fascinating organ systems
to evaluate. The intrinsic ability of the GI tract to resist toxic chemicals has led to a
paucity of data regarding GI toxicology. The GI tract is the entry site into the body
of orally administered compounds that may be highly toxic to other internal
organs, but have little or no noticeable effect on the GI tract. Nevertheless, this
organ system can be readily perturbed, leading to obvious toxic responses. Some of
these responses are readily identifiable, such as emesis or diarrhea. Other
perturbations, such as the insufficiency of some enzymes, changes in functions
(such as excess production of mucus or delayed emptying), localized inflammation
or neoplastic changes, are more difficult to identify and attribute to toxicological
processes

The principal functions of the GI tract that are subject to toxic effects of chemicals
include storage, propulsion, digestion, absorption, secretion, barrier activity, and
elimination. Due to the importance of nervous reflexes and hormones in the
regulation of the GI tract, this system is relatively unique, in that toxic effects at
one site (e.g., stomach) may be expressed at another site (e.g., colon).

A distinctive feature of the GI tract is the high proliferative and metabolic rate of
the mucosa. The mucosa is a complex barrier that must exclude bacteria and their
toxic byproducts, and yet absorb nutrients vital for homeostasis. The GI tract is
also the only internal organ that contains biotransforming and toxigenic bacteria, as
well as inert drug-binding materials. Consequently, when a compound is placed
into the GI milieu, the ultimate toxicity to this organ system is determined by
interactions of the chemical with bacterial and mammalian enzymes, as well as by
the extent of detoxification or activation processes.

In addition, the GI tract is exquisitely sensitive to autolysis and postmortem

alterations, due to its high luminal bacterial content and high metabolic activity.
Many subtle toxicologic events that occur at the cellular and subcellular level may
only be observed by careful and proper handling of the GI tissues at postmortem
examination, or during sample collection. All of these factors, and numerous
others, provide many challenges to the toxicologist or pathologist who is
evaluating the GI tract as a target organ system in toxicologic pathology

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GASTROINTESTINAL TRACT DISORDER

The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the
tract or passageway of the digestive system that leads from the mouth to the anus.
The GI tract contains all the major organs of the digestive system, in humans and
other animals, including the esophagus, stomach, and intestines. Food taken in
through the mouth is digested to extract nutrients and absorb energy, and the waste
expelled at the anus as faeces. Gastrointestinal is an adjective meaning of or
pertaining to the stomach and intestines.

Most animals have a "through-gut" or complete digestive tract. Exceptions are

more primitive ones: sponges have small pores throughout their body for digestion
and a larger dorsal pore for excretion, comb jellies have both a ventral mouth and
dorsal anal pores, while cnidarians and a coels have a single pore for both digestion
and excretion.

The human gastrointestinal tract consists of the esophagus, stomach, and intestines,
and is divided into the upper and lower gastrointestinal tracts. The GI tract includes
all structures between the mouth and the anus,[4] forming a continuous passageway
that includes the main organs of digestion, namely, the stomach, small intestine,
and large intestine. The complete human digestive system is made up of the
gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary
glands, pancreas, liver and gallbladder).

The tract may also be divided into foregut, midgut, and hindgut, reflecting
the embryological origin of each segment. The whole human GI tract is about nine
meters (30 feet) long at autopsy. It is considerably shorter in the living body
because the intestines, which are tubes of smooth muscle tissue, maintain
constant muscle tone in a halfway-tense state but can relax in spots to allow for
local distention and peristalsis.

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Structure of Gastrointestinal Tract
The structure and function can be described both as gross anatomy and
as microscopic anatomy or histology. The tract itself is divided into upper and
lower tracts, and the intestines small and large parts. The gastrointestinal tract
(GIT) is about 10 feet muscular hollow tube which is bounded by the mouth at one
end and the anus at other. It stretches from the mouth to esophagus, stomach, small
intestine, large intestine and finally to the anus; through which food is processed
for digestion, absorption and elimination of the undigested and unabsorbed part.
The histological architecture of GIT comprises epithelium, lamina propria,
muscularis mucosa, submucosa, submucosa plexus, circular muscle myentric
plexus, longitudinal muscle and serosa .

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  Upper gastrointestinal tract

The upper gastrointestinal tract consists of the mouth, pharynx, esophagus,

stomach, and duodenum. The exact demarcation between the upper and lower
tracts is the suspensory muscle of the duodenum. This differentiates the embryonic
borders between the foregut and midgut, and is also the division commonly used
by clinicians to describe gastrointestinal bleeding as being of either "upper" or
"lower" origin. Upon dissection, the duodenum may appear to be a unified organ,
but it is divided into four segments based on function, location, and internal
anatomy. The four segments of the duodenum are as follows (starting at the
stomach, and moving toward the jejunum): bulb, descending, horizontal, and
ascending. The suspensory muscle attaches the superior border of the ascending
duodenum to the diaphragm.
The suspensory muscle is an important anatomical landmark that shows the formal
division between the duodenum and the jejunum, the first and second parts of the
small intestine, respectively. This is a thin muscle which is derived from
the embryonic mesoderm.

The upper GI consists of the following organs:

Mouth
It includes the teeth, tongue, and buccal mucous membranes containing the ends of
the salivary glands that continue with the soft palate, floor of the mouth, and
underside of the tongue. Mouth functions by chewing the food, constantly by the
muscular action of the tongue, cheeks, and teeth through the lower jaw and upper
jaw.

Pharynx
The pharynx is enclosed in the neck and functions as part of both the digestive
system and the respiratory system. It protects the food from entering the trachea
and lungs.

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Oesophagus
A muscular tube-like structure that functions by carrying food to the stomach.
Once the chewed food reaches the oesophagus from the mouth, the action of
swallowing becomes involuntary and is controlled by the oesophagus.

Stomach
This is where most of the digestion takes place. The stomach is a J-shaped bag-like
organ that stores the food temporarily, breaks it down, mixes and churns it
with enzymes and other digestive fluids and finally, passes it along to the small
intestine.

 Lower gastrointestinal tract

he lower gastrointestinal tract includes most of the small intestine and all of
the large intestine. In human anatomy, the intestine : is the segment of the
gastrointestinal tract extending from the pyloric sphincter of the stomach to
the anus and as in other mammals, consists of two segments: the small
intestine and the large intestine. In humans, the small intestine is further
subdivided into the duodenum, jejunum, and ileum while the large intestine is
subdivided into the cecum, ascending, transverse, descending, and
sigmoid colon, rectum, and anal canal.
 Small intestine
The small intestine begins at the duodenum and is a tubular structure, usually
between 6 and 7 m long. Its mucosal area in an adult human is about
30 m2 (320 sq ft). The combination of the circular folds, the villi, and the microvilli
increases the absorptive area of the mucosa about 600-fold, making a total area of
about 250 m2 (2,700 sq ft) for the entire small intestine. Its main function is to
absorb the products of digestion (including carbohydrates, proteins, lipids, and
vitamins) into the bloodstream. There are three major divisions:

1. Duodenum: A short structure (about 20–25 cm long) that

receives chyme from the stomach, together with pancreatic
juice containing digestive enzymes and bile from the gall bladder. The
digestive enzymes break down proteins, and bile emulsifies fats
into micelles. The duodenum contains Brunner's glands which produce a
mucus-rich alkaline secretion containing bicarbonate. These secretions, in

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 combination with bicarbonate from the pancreas, neutralize the stomach
acids contained in the chyme.
2. Jejunum: This is the midsection of the small intestine, connecting the
duodenum to the ileum. It is about 2.5 m (8.2 ft) long and contains
the circular folds also known as plicae circulares and villi that increase its
surface area. Products of digestion (sugars, amino acids, and fatty acids) are
absorbed into the bloodstream here.
3. Ileum: The final section of the small intestine. It is about 3 m long, and
contains villi similar to the jejunum. It absorbs mainly vitamin B12 and bile
acids, as well as any other remaining nutrients

 Large intestine
The large intestine, also called the colon, forms an arch starting at the cecum and
ending at the rectum and anal canal. It also includes the appendix, which is
attached to the cecum. Its length is about 1.5 m, and the area of the mucosa in an
adult human is about 2 m2 (22 sq ft). Its main function is to absorb water and salts.
The colon is further divided into:

1. Cecum (first portion of the colon) and appendix

2. Ascending colon (ascending in the back wall of the abdomen)
3. Right colic flexure (flexed portion of the ascending and transverse colon
apparent to the liver)

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4. Transverse colon (passing below the diaphragm)
5. Left colic flexure (flexed portion of the transverse and descending colon
apparent to the spleen)
6. Descending colon (descending down the left side of the abdomen)
7. Sigmoid colon (a loop of the colon closest to the rectum)
8. Rectum
9. Anal canal

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GASTROINTESTINAL TRACT DISEASES

Few of the gastrointestinal tract diseases include:

Constipation
Constipation refers to infrequent or incomplete bowel movements. This is caused
due to inadequate consumption of dietary fibre and water in the diet.

Constipation is a common functional disorder in the gastrointestinal system. An

infrequent and difficult/incomplete bowel movement along with pain and stiffness
are the common symptoms which can further develop fissures and hemorrhoids. Its
global prevalence is up to 80%, varying with different geographical and cultural
variations. It is more common in old age people or adults in 65 or above age group.
It occurs mainly due to absence of the fibres in diet, less intake of fluid, unhealthy
food habits and sedentary lifestyle. Other reasons can be side effects of medication
or as a symptom of some neurological or systematic diseases, etc.

It is also seen in pregnant women mainly in the last months of pregnancy due to
high levels of sex hormones, lack of movement and medications. Constipation can
be treated by improving dietary habits, inclusion of more fibers and fluids and
adopting a healthy lifestyle by including exercise in routine. In severe conditions,
one should opt for laxatives as prescribed by physician and also get colon cancer
screening done.

Diarrhea

Diarrhea is generally characterized by the frequent bowel movement due to

decreased fluid absorption in intestine, and passage of loose liquid stool along with
stomach pain and cramps. It is a common disease in children below age of 5 years.
It is generally caused by pathogenic bacteria, viruses and other parasites which
enter the body via consumption of contaminated food and water, due to poor
hygiene and living in unsanitary conditions. The contaminated food contains

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pathogenic bacteria, virus and other parasites. It can also be a symptom of other
bowel disorders like inflammatory bowel disease. During diarrhea, one should
rehydrate himself frequently to overcome excess loss of water from the body. Oral
Rehydration Solution (ORS) should be administered which replenishes electrolytes
loss in intestine. Zinc supplements also reduce severity of diarrhea. Adding more
fluids in the diet along with nutrient-rich meal helps in reducing severity.
Maintaining cleanliness, practicing personal hygiene and consumption of clean and
preferably boiled drinking water is advised.

Irritable Bowel Syndrome

This is a condition in which the colon muscle contracts more often than in normal
people. It causes bloating, abdominal pains and cramps, diarrhoea, etc.
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the
colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being
the principal types. Crohn's disease affects the small intestine and large intestine,
as well as the mouth, esophagus, stomach and the anus, whereas UC primarily
affects the colon and the rectum In spite of Crohn's and UC being very different
diseases, both may present with any of the following symptoms: abdominal pain,
diarrhea, rectal bleeding, severe internal cramps/muscle spasms in the region of the
pelvis and weight loss.

Anemia is the most prevalent extraintestinal complication of inflammatory bowel

disease (IBD). Associated complaints or diseases include arthritis, pyoderma
gangrenosum, primary sclerosing cholangitis, and non-thyroidal illness syndrome
(NTIS).[11] Associations with deep vein thrombosis (DVT) and bronchiolitis
obliterans organizing pneumonia (BOOP) have also been reported. Diagnosis is
generally by assessment of inflammatory markers in stool followed
by colonoscopy with biopsy of pathological lesions.

Regurgitation

Regurgitation is the sudden rise of undigested food along with some gastric juices
back up to the mouth; it usually leaves a sour taste in the mouth with a sense of
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fluid moving up and down in the chest. It is normal in babies for first year of life.
In adults it is a symptom of acid reflux, gastroesophageal reflux disease (GERD) or
rumination disorder. It occurs mainly due to the eating disorder, blockage of
esophagus (due to scarring or cancer), side effect of some medication and smoking.
It is usually experienced by the pregnant women. To treat this condition, you
should eat slowly, chew food properly, avoid smoking, avoid food that triggers
reflux, walk after every meal and maintain a healthy lifestyle.

Peptic ulcer

The common agent of peptic ulcer is the bacterial infection. It is caused by

Helicobacter pylori (H. pylori) that causes internal wounds on the inner lining of
stomach (Gastric ulcers) and the small intestine (Duodenal ulcers) (Fig. 9.13).
Symptom of peptic ulcer includes burning sensation in stomach and stomach pain.
Stress and spicy foods can worsen the symptoms of this disease. The antacids and
eating certain foods also help to reduce the symptoms of peptic ulcer.

Colon Cancer
Colon cancer begins in the large intestine aand affects older people. It begins as
small, non-cancerous clumps. These clumps gradually convert to cancer. It can be
treated with surgery, chemotherapy, and radiation therapy.

Haemorrhoids
These are swollen blood vessels that line the opening of the anus. They are caused
by excess pressure due to the strenuous movement of the bowel.

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Gastrointestinal cancer
Gastrointestinal cancer refers to malignant conditions of the gastrointestinal
tract (GI tract) and accessory organs of digestion, including the esophagus,
stomach, biliary system, pancreas, small intestine, large intestine, rectum and anus.
The symptoms relate to the organ affected and can include obstruction (leading to
difficulty swallowing or defecating), abnormal bleeding or other associated
problems. The diagnosis often requires endoscopy, followed by biopsy of
suspicious tissue. The treatment depends on the location of the tumor, as well as
the type of cancer cell and whether it has invaded other tissues or spread
elsewhere. These factors also determine the prognosis.
Overall, the GI tract and the accessory organs of digestion (pancreas, liver, gall
bladder) are responsible for more cancers and more deaths from cancer than any
other system in the body.[1][2] There is significant geographic variation in the rates
of different gastrointestinal cancers.

 Digestion and absorption of carbohydrates, fats and proteins in

the Gastrointestinal tract

Digestion initiates the breaking down of food and converts them smaller nutrients
so the body can process for metabolism in order to generate energy for
physiological process of the body. Our daily diet contains approximately 50-60%
carbohydrates. The principal carbohydrates are starch (polysaccharide), lactose
(milk sugar), sucrose and maltose. Carbohydrates are found in whole-grain breads
and cereals, legumes, fruits, vegetables, milk, and milk products. All carbohydrates
need to be digested to glucose, galactose, and fructose for absorption in the body.
Breakdown of sugars is initiated in the mouth by salivary amylase.

Subsequent digestion of carbohydrates takes place in small intestine with the help
of pancreatic amylase and three enzymes secreted by intestinal epithelium
(Lactase, Sucrase, and Maltase). Digested carbohydrates are then absorbed by villi
present in the small intestine. The end product of polysaccharide and disaccharide
is mostly the glucose. The glucose is absorbed by active and passive diffusion in
the blood capillaries of jejunum and upper ileum. These are carried to the liver
through hepatic portal system.

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  Digestion and absorption of Proteins

Proteins are the source of amino acids which are important for the growth and
development of human body. Protein sources in our diet are milk, milk products,
meat, eggs, and legumes. Digestion of protein occurs in the stomach by protease
and pepsin enzymes. Acidic pH of stomach helps in protein digestion. Trypsin and
chymotrypsin released in duodenum by pancreas digests proteins, peptones and
proteoses into dipeptides. In the small intestine, erepsin, a group of several
proteolytic enzymes acts primarily and rapidly on peptones and polypeptides,
degrading them into simpler molecules amino acids. Proteins are finally digested to
amino acids to be absorbed by the small intestine into the blood, which are then

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carried throughout the body. The absorption of amino acids is rapid in the
duodenum and jejunum.

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  Digestion and absorption of Fats

Dietary foods such as oil and ghee are source of fats. The triglycerides, fatty acids,
glycerol and phospholipids are common form of fats. Fats being hydrophobic are
present as insoluble form in stomach. They are emulsified by bile salts present in
the bile juice and then digested by pancreatic lipase into dilgycerides and
monoglycerides with release of associated fatty acids (Fig. 9.12). Bile salts exerts a
detergent action to activate lipase for fat digestion. Upon digestion, fat breaks
down to fatty acids and glycerol and then binds with the bile acids, pancreatic
electrolytes which spontaneously form polymolecular aggregates structure called
micelles. Micelles are smaller molecules (diameter 3-10 nm) which passively move
across the small intestine and form triglycerides. These combine with proteins and
form protein-coated fat globules, called chylomicrons, which are transported into
the lymph vessels (lacteals) in the villi. These lymph vessels ultimately release the
absorbed substances into the blood stream. Fat absorption occurs in the upper part
of small intestine.

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REFERENCES
WWW.GOOGLE.COM

WWW.WIKIPEDIA.COM

SCIENCE DIRECT.COM

WWW.ACCESSMEDICINE.COM

OXFORD ACADEMY.COM

WWW.SPRINGER.COM

ELSEVIER.COM

WWW.BRITANNICA.COM

NATIONAL INSTITUTES OF HEALTH-OGOBUIRO

TECHME ANACOMY.COM

KHAN ACADEMY

MERRIUM WEBSTER

WWW.LIBRARYTEXTS.COM

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